Service Planning Research Articles

The Role of Machine Learning in Enhancing Corporate Financial Planning

Aim: To examine the role of machine learning in enhancing corporate financial planning. Problem Statement: In the past, corporate financial planning relied on statistical models and expert judgment which are often constrained by predefined assumptions and historical data. By so doing, they usually struggled to handle the non-linear and dynamic nature of financial markets causing limitations in their responsiveness and predictive power. Significance of Study: There is need to incorporate machine learning in corporate financial planning to provide a transformative technique via the introduction of advanced algorithms which are capable of analyzing diverse and vast datasets to uncover sophisticated relationships and patterns. Methodology: Recent relevant published articles in the area of machine learning in enhancing corporate financial planning were consulted. Relevant articles were sourced from the internet using the Google search engine. The abstract of the consulted published articles were thoroughly examined to study their relevance to the subject matter. Discussion: This review article examines the role of machine learning in enhancing corporate financial planning. It was found that machine learning techniques have crucial roles to play in the context of corporate financial planning via decision-making improvement, risk management, operational efficiency enhancement, fraud detection and enabling personalized experiences. Also, Machine Learning technologies have a wide variety of uses in corporate financial planning which enable banks and insurance companies in delivering tailored experiences that give their customers some preferences. Common identified machine learning approaches in corporate financial planning include predictive analytics, natural language processing, computer vision, reinforcement learning and anomaly detection approaches. Major areas of machine learning application include dynamic pricing and offers; regulatory compliance; personalized customer service; predictive analytics for customer retention; personalized product recommendations and so on. Furthermore, the implementation of Machine Learning (ML) in corporate financial planning and financial services industry provides many chances for enhancing customer experiences, improving efficiency and driving innovation. However, ML poses numerous challenges which should be addressed to attain the complete potential of these technologies. Conclusion: As technology continues to advance, financial institutions will need to route the challenges of bias mitigation, transparency and regulatory compliance while the ML full potential is equally leveraged. Also, machine learning has the potential to transform corporate financial planning via the provision of more adaptive, accurate and real-time insights.

Shifting Sands: Examining and Mapping the Population Structure of Greece Through the Last Three Censuses

This paper aims to facilitate a more nuanced understanding of regional disparities in the population age structure at a local scale by applying a recent method for visualizing these disparities. Utilizing data from the three most recent population censuses in Greece, this method applies advanced data visualization techniques to map age distributions, highlighting significant variations in aging patterns across municipalities, towns, and districts. Traditional demographic analysis often overlooks local heterogeneities, leading to broad policies that often fail to address the unique needs of specific regions. Detailed maps are created by integrating geographic data with census data (using R and GIS), enabling policymakers to pinpoint areas with specific demographic challenges and opportunities. This localized approach reveals critical insights, such as regions experiencing rapid population aging, areas with younger population profiles, and zones undergoing demographic transitions. The visualization tool significantly improves the formulation of targeted strategies, enhancing the effectiveness of policies related to healthcare, workforce planning, and social services distribution. Through case studies and comparative analysis, we demonstrate the practical applications and advantages of this method in shaping public policy and strategic planning. This paper contributes to the field of geodemography by introducing and demonstrating a visualization method that enhances the accuracy of demographic analysis, providing policy makers with useful information to better address local demographic challenges and tailor strategies to specific regional needs.

Influence of male targeted short message service on knowledge, nature of attitude and male involvement on uptake of family planning among spouses in Marsabit County, Kenya

Background: Family planning services helps the individuals or couples to regulate the number and determine healthy spacing and timing of pregnancies. Globally, contraceptive prevalence stands at 49.0%, Sub-Saharan Africa at 29.0%, Kenya at 56.9% and Marsabit County at 5.6%. Some of the reasons given for low uptake include low knowledge level, negative attitude and lack of male involvement on family planning matters. This study aimed at establishing the influence of male targeted short message service on knowledge, nature of attitude and male involvement on uptake of family planning among spouses in Marsabit County. Methods: A pre-test and post-test quasi experimental study design was adopted involving randomly selected 220 couples from Laisamis (control group) and Moyale (intervention group) sub-counties. Intervention of male targeted short message service was offered weekly to male spouses from Moyale sub-county. A questionnaire was used to collect data. Data analysis was done using SPSS. All the required ethical and logistical considerations were adhered to accordingly. Results: Male targeted short message service increased level of knowledge significantly (OR 4.173, p=0.001), changed nature of attitude (OR 2.7335, p=0.004) and male involvement in family planning (OR 4.4306, p=0.001). Conclusions: The study concluded male targeted SMS intervention increased level of knowledge, attitude changed and males were involved. The County government of Marsabit should engage opinion leaders in family planning to help in educating and changing the attitude of the men towards family planning.

Reform of the Irish health system towards Universal Health Coverage and the role of the private sector

Abstract Introduction Ireland stands as a compelling case study of a High Income Country setting out on Universal Health Coverage (UHC) reforms. The Irish health system has historically been a two-tier system with a large private sector and a high proportion of the population holding private health insurance (48% in 2023). The reform programme Sláintecare, adopted as a policy direction by all political parties, aims to introduce UHC, strengthen primary care capacity, address inequitable access and decentralise decision-making. The overall aim of this study is to chart the progress of the Sláintecare reforms, from their introduction in May 2017 up to December 2023, and to explore how they have changed throughout implementation. Methods A document analysis was undertaken using the READ approach. Department of Health publications, Budget reports, Service Plans, National Development plans, minutes of Health Service Executive committee meetings and transcripts of the Joint Committee of Health sessions in the Irish parliament were uploaded to NVivo and a content analysis was conducted, utilising predetermined themes. Results Areas that have made the most significant progress include the expansion of community care and lowering of some out-of-pocket costs. Since implementation began, one approach the government has taken has been to use the private sector to fill capacity gaps in the public system. For example, strategies for reducing waiting lists and using community diagnostics have largely used the private sector. However, through using the private sector, money is taken away from building capacity in the public system, which was the original goal of Sláintecare. Conclusions The private sector plays a significant role in providing care in Ireland and leveraging this for the benefit of public patients could play a positive role towards UHC, provided that funding for a purchaser-providers type model for some services from the government could be guaranteed into the future.

Health status by time of arrival among Ukrainian refugees in Norway

Abstract Background Over 75000 refugees from Ukraine have come to Norway since February 2022. Previous studies show that the refugees have poor health for several domains, and reports suggest that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to measure self-reported health in a sample of adult refugees from Ukraine according to month of arrival to Norway in 2022. Methods Data were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22 - 31.01.23. Recruitment was via multiple potential physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of Hopkins Symptom Checklist (HSCL-5). Results Among 727 respondents, 82% were female, 65% aged 30-49 years, 69% had higher education and 53% responsibility for children in Norway. 383 arrived February-April (T1), 200 May-August (T2) and 144 September-December (T3). Compared to T1, later periods had higher proportions of males, a younger age distribution and lower proportions with higher education. Proportions reporting poor/very poor overall health, presence of long-term illness, and long-term disability were highest in T3. Oral health and HSCL-5 showed an opposite trend, with lower proportions reporting poorer health in both later periods. Respondents in T3 were still more likely to report poor health and long-term illnesses after adjusting for sex, age and education. Conclusions Respondents arriving later in 2022 generally reported poorer long-term health, but less psychological distress than those arriving earlier. These findings may help to inform planning of health services to refugees from Ukraine, especially in areas receiving large numbers of refugees. Key messages • Refugees from Ukraine arriving earlier to host countries appear to have generally better health compared to those arriving later. • Refugee health services should plan and scale accordingly when large numbers of refugees are expected as a result of international crises.

Digital health spaces in the city of Lisbon. The role of digitalization in linking boundaryless hospitals and smart health cities

Abstract Digital transformation is reshaping every aspect of society, including healthcare. The concepts of ‘Boundaryless Hospitals’ (BH) and ‘Smart Health Cities’ (SHC) represent a forward-thinking approach to healthcare that leverages digital technologies to enhance service delivery, operational efficiency and patient outcomes, including healthy mobility. This session delves into the complex role of digitalization in creating interconnected health and spatial environments where the flow of data and resources across physical and virtual barriers is optimized. BH embody a healthcare model where digital tools, health information systems and AI-powered diagnostics are integrated to provide care that transcends traditional hospital walls into the city. This approach not only facilitates greater accessibility and flexibility in patient care but also enhances the capacity for healthcare providers to offer personalized and timely interventions, embracing public health altogether. SHC integrates health technology into urban planning and public health services to create ecosystems that actively contribute to the health and wellbeing of their populations. Using big data analytics, IoT and other digital infrastructures, these cities support sustainable health practices, disease prevention, and efficient crisis response, promoting an overall healthier populace. This session will explore how digital health spaces can bridge the gap between these concepts. Discussions will focus on public health challenges and opportunities, examining the case of the city of Lisbon on how digital platforms can facilitate interactions between healthcare providers, patients, and urban environments. Best practices from pioneering projects around the globe will be highlighted. Participants will engage in comprehensive analyses of Lisbon case that demonstrate successful integration of digital health technologies in various contexts, contributing to the resilience and adaptability of healthcare infrastructures.

6.G. Scientific session: The importance of using country-specific severity distributions in burden of disease indicators

Abstract One of the most commonly used health gap summary measures in the field of public health is the Disability-adjusted life year (DALY). It has become the key metric for quantifying the burden of disease (BoD) and is used as an information source for setting priorities for health care and health service planning. The DALY metric quantifies gaps between a theoretical population in perfect health and the current health status related to both morbidity and mortality. It is the sum of the number of healthy life years lost due to disability (YLD) and death (YLL). The YLD summarises the loss of healthy life time using the frequency of diseases differentiated by severities or related health states (including sequelae). Depending on each health state, it converts the time spent with diseases into YLD by weighting each year with health limitation with so-called disability weights. This allows the two indicators YLL and YLD to be added to the DALY. Consequently, severity distributions are a means of describing the range of health loss along specific health states, which enables an accurate mapping with disability weights. For most of the diseases, these distributions are usually categorised as mild, moderate, severe, or no health loss (asymptomatic). Conditions with higher severity levels contribute more to the YLD and thus, to the overall disease specific BoD. The severity distributions are highly dependent on utilization at the individual level, but also on available health care services at the society level, which indicates that differences by settings are to be expected. Changes over time in the share of severe cases, for instance, may reflect the effectiveness of health interventions and policies. This underlines the importance of severity distributions, as they also reflect information about the quality of healthcare for those affected. The Global Burden of Disease (GBD) study applies for a significant proportion of their considered diseases uniform severity distributions across countries and broader regions. They acknowledge concerns over applying estimates of severity distributions based on limited data, noting that it is the only available information that they were able to use. As the YLD estimates are often utilized to develop and prioritize health policy interventions, there is a necessity for country-specific estimates that are evidence based and less susceptible to model assumptions. In most cases, the estimation of severity distributions involves complex methodology as data for such assessments are very limited or hardly reliable. In the following workshop, general concepts and country cases from Germany, Scotland, and Belgium will be presented covering a variety of diseases. The examples underline the importance of estimating national and even regional severity distributions when identifying the importance of diseases or comparing the health conditions of populations across time. Key messages • As the Burden of disease indicators are predominantly used to prioritize health interventions and allocate resources, it is crucial to use accurate information in the severity levels of disease. • Severity distributions reflect the health care services and vary across different settings. Utilising country-specific severity distributions when estimating Burden of Disease indicators is essential.

Towards more effective health monitoring: a comparison of different data sources

Abstract Background Monitoring the prevalences of chronic diseases and their risk factors at the population level is important to support effective prevention measures, health service planning and health policy-making. The utilization of register information is cost-effective in population health monitoring, but the validity of information is important to assess. The aim of this study was to compare the information on most common chronic diseases and risk factors collected from a population-based Healthy Finland survey and national health registers. Methods The study population comprised of 4785 individuals aged 20 years or over from the nationally representative Healthy Finland Health Examination Survey conducted in 2023. Information on the most common chronic diseases were derived from both survey data (including measured and self-reported data) and the national registers. The prevalence in survey data were compared with prevalence in register data for those individuals who participated in the survey. Register data was examined for the previous five years and was obtained from the Care Register for Health Care and medical registers, depending on availability of data. Weighted prevalences were calculated taking into account the sampling design and non-response. Results For all examined risk factors and diseases, the prevalence was higher in survey data than in register data. The difference was the greatest for elevated blood pressure: the prevalence in survey data was 48.6% (95% CI 46.5, 50.7) versus 17.3% (15.6, 19.0) in register data. The prevalence of diabetes was 11.5% (10.4, 12.5) in survey and 6.9% (5.9, 7.9) in register data. For sleep apnea, the prevalence in survey data was 8.4% (7.4, 9.3) and 4.4% (3.7, 5.1) in register data. Conclusions Register-based information provides more reliable prevalences on diseases needing urgent treatment. Survey data brings out also previously unidentified diseases cases that do not show in registers. Key messages • Register data is cost-effective in health monitoring, but surveys are needed for monitoring risk factors. • Utilizing diverse data sources enhances getting reliable information to support decision-making.

Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria

Abstract Objectives The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria. Methods We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses. Results We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented. Discussion STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF Key messages • New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing. • Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

How have respiratory tract infections changed in the post-covid era for children under 5 years?

Abstract Background Social distancing measures introduced in response to the covid-19 pandemic reduced transmission of all respiratory pathogens. Exposure to respiratory pathogens in early life affects future lung health. We aimed to describe changes in the incidence of respiratory tract infections (RTIs) in children <5 years in England in the post-pandemic era. Methods Population-based retrospective cohort study using electronic health records. We included all children aged <5 years registered with a primary care practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs in the two post-pandemic years (April 2021 - March 2022 and April 2022 - March 2023) with corresponding months during pre-pandemic years (April 2016 - February 2020). Results There were 3 045 701 respiratory tract infections among 2 894 539 children <5 years registered with a GP practice during the study period. Pre-pandemic, monthly RTI rates varied from lows of 29.1 per 100 child-years in August to highs of 108.8 per 100 child-years in November. In 2021/22, monthly RTI rates were bimodal peaking in June and October, although the winter peak was lower than pre-pandemic years and mean monthly RTI rates were ∼15% lower overall. In 2022/23 mean monthly RTI rates remained ∼15% lower than pre-pandemic years, but there was a single peak in December 2022 of 117.6 RTIs per 100 child-years, exceeding the pre-pandemic winter peaks by 8.1%. Conclusions Overall, monthly RTIs in post-pandemic years were 15% lower than pre-pandemic years. However, there was a concerning peak in December 2022 that exceeded the winter peaks from previous years. Comparisons with national surveillance data suggest this peak reflects changes in RTI incidence, particularly among group A streptococcal infections, but this peak may also reflect changes in access to care or healthcare seeking behaviour. Continued monitoring of post-pandemic seasonal patterns will assist in planning for health service use. Key messages • Respiratory tract infections in children <5 years in post-pandemic years were 15% lower than pre-pandemic years, but winter peaks in incidence may be of greater magnitude in the post pandemic era. • Ongoing monitoring of patterns of respiratory tract infections in young children is important for future health service planning and delivery.

Prevalence and incidence of chronic wounds in Austria - a population-based real-world data analysis

Abstract Background Chronic wounds are associated with pain, odor, loss of mobility, an increased risk for infection and sepsis and a reduced quality of life. Treatment costs are rising due to the longevity of the population and increasing number of diabetes cases. For service planning in healthcare, it is thus necessary to describe patient characteristics and estimate the prevalence and incidence of chronic wounds. Currently, no data exists on this subject broken down by age group, gender, and province in Austria. Methods A retrospective analysis of real-world data was conducted using two merged datasets from an outpatient wound centre and the Austrian Health Insurance Fund. The study population consisted of people who resided in Austria and were covered by statutory health insurance from 2018 to 2022. We performed a descriptive, socio-demographic analysis of the data of patients, followed by a set of cluster analyses using the unsupervised K-means algorithm. From these clusters, we derived subgroup characteristics and patient trajectories and calculated prevalence and incidence rates for chronic wounds according to diagnoses, different age groups, gender, and different regions. Results Gender was almost evenly distributed in the wound centre’s data set (n = 4963; 49.6% female). The age distribution revealed the age group from 71-80 years being the largest group. In general, more women than men are affected by chronic wounds from the age of 81 onwards. 31% of chronic wound patients had diabetes as an underlying condition. More men were affected by peripheral arterial occlusive disease and diabetic foot syndrome and, conversely, more women by chronic venous insufficiency. These are preliminary results of the analyses. Conclusions Chronic wound patients were characterised by older age and multi-morbidity. Interestingly, gender differences appeared in the occurrence of comorbidities. Key messages • This study makes a crucial contribution in making routine data usable for the epidemiological study of chronic wounds, a cluster of diseases of complex aetiology. • It thus contributes to filling a knowledge gap. The prevalence estimate serves as a basis of knowledge for health care planning and a basis for the health economic assessment of the problem.

6.D. Skills building seminar: Family Vulnerability Scale: Why and how to use at Primary Health Care to promote health equity?

Abstract Family vulnerability encompasses multiple perspectives that are interconnected with the health needs of each family member. Families experiencing vulnerability face heightened risks of poor health outcomes. Nonetheless, these vulnerabilities are further compounded by systemic inequalities within healthcare systems, where biological or clinical factors are exclusively considered to organize and/or prioritize access, especially given the scarcity of valid instruments to measure family vulnerability. Primary Health Care (PHC) plays a pivotal role in addressing health inequalities, especially considering its bond with community. From this context, the Family Vulnerability Scale for Brazil (EVFAM-BR, in Portuguese) was developed and validated, been composed of 14 items about four dimensions (income, healthcare, family and violence) (2019-2023). By reducing the gap between science and practice, the implementation process of EVFAM-BR was started at the same year the scale was validated (2023). First, it occurred at 14 PHC services in São Paulo (Southeast Region, Brazil) and second, since 2024 has been implemented at Boa Vista (North Region, Brazil). Also, between 2024 and 2026, the implementation of EVFAM-BR is expected to take place in other Brazilian states participating in the third phase of the PlanificaSUS project, which is developed aiming to support State health departments to implement the Health Care Planning method to organize and integrate PHC and specialized outpatient care based on population health care needs. At this stage, capacity building is needed to align the concept of family vulnerability and to train PHC managers and health professionals on how to apply and use results from EVFAM-BR. This training has already been performed for around 1,000 health professionals from two different regions of Brazil, including managers, Community Health Workers, nurses, and physicians. The present workshop proposal aims to disseminate the EVFAM-BR and to offer the EVFAM-BR experience. It proposes knowledge transferring throughout participants engagement at three activities. Activity 1) “Family Vulnerability: From concept to a scale validity and application”: it is designed to engage participants to discuss about the family vulnerability concept and applicability at PHC, and to discuss on how EVFAM-BR implementation process has been occurring at Brazil and how can be tailored to other contexts. Activity 2) “Role Play: Practicing EVFAM-BR”: Two cases will be used for role play dynamics that will take place in trios, in which one will represent the community health worker, another will be the patient and the third will be the observer. Activity 3) That ones that assumed observer role will share their experiences of using EVFAM-BR. Finally, a discussion will be facilitated based on the participants’ impressions and a review of the main points covered throughout the workshop. Key messages • Family vulnerability stratification (through EVFAM-BR) is essential to plan services achieving equity and qualified population-based care management and to qualify patient approach and care. • Family Vulnerability Scale (EVFAM-BR) training represents efforts to reduce the gap between research and practice and contributes to address social determinants of health on healthcare.

Characteristics of Technological Disasters.

Disasters are the consequences of natural or technological hazards that affect a vulnerable society.1 Technological disasters are divided into three groups: industrial, transport, and miscellaneous.2,3 It is possible to determine the risks of technological disasters, to determine priorities, and to plan services by knowing this epidemiology.4 In this study, we aimed to define the distribution and characteristics of the subtypes of technological disasters in the world according to regions and years. Our study was conducted using the international dataset at www.emdat.be/. The technological disasters between 1970 and 2020, the years they occurred, their locations (region and continent), the types of disasters, and the numbers of dead and affected were recorded. We found that the greatest number of disasters occurred between 2001 and 2010. The most common type of disaster was transportation accidents. While the continent with the most frequent disasters was Asia (3 879 [45.6%]), it was followed by Africa (2 220 [26.1%]) and South and North America (1 359 [16%]). Transport accidents are the most common cause of technological disasters, and road accidents are the most common type of transport accident.

Women's Responsiveness and Utilization of Family Planning and Childhood Immunization Services at Primary Health Care Clinics

Women's Responsiveness and Utilization of Family Planning and Childhood Immunization Services at Primary Health Care Clinics

An example of a field service plan for oceanographic submerged moorings

Oceanographic mooring missions are critical for advancing our understanding of the world’s oceans and their role in the broader Earth system. These missions rely on the deployment and maintenance of complex observing systems, comprising subsurface, profiling, and surface moorings, which are designed to collect valuable data from the ocean interior. The success of these missions depends on meticulous planning and strategic execution, which are facilitated by the use of Field Service Plans (FSPs). FSPs are comprehensive and adaptable planning tools that integrate safety measures, contingency plans, and timelines to ensure the successful and safe recovery, maintenance, and deployment of mooring systems. In this paper, we provide a comprehensive guide to drafting, implementing, and adapting FSPs tailored to the unique challenges posed by oceanographic mooring missions. We highlight the critical role of FSPs in optimizing safety, data quality, and mission success, while also underscoring the need for flexibility and adaptation. Our aim is to provide practical guidance and a template for researchers, expedition leaders, and institutions engaged in oceanographic research.

Simulated GP clinic closure: effects on patient access in the Irish Mid-West.

Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access. GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic. The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index ≥4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31). Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.

Perspectives of healthcare providers around providing family planning services to women living with HIV attending six HIV treatment clinics in Lusaka, Zambia

ABSTRACT While international guidelines recommend integration of family planning (FP) and HIV services, limited research has been done to explore how healthcare providers perceive the feasibility and utility of integrated services. To address this gap, we administered a standardized questionnaire to 85 providers from 6 HIV clinics in Lusaka, Zambia, before (April–May 2018) and after (May–June 2019) implementing an enhanced model of FP/HIV service integration. We tested for differences in FP knowledge, attitudes and practices between the two time periods with tests appropriate for paired observations. The proportion of providers self-reporting direct provision of contraceptives increased significantly for several methods including oral contraceptives (14% vs. 26%, p = 0.03), injectables (9% vs. 25%, p < 0.001), implants (2% vs. 13%, p = 0.007) and intra-uterine devices (2% vs. 13%, p = 0.007). In-depth interviews were also conducted post-integration with 109 providers to solicit their feedback on the benefits and challenges of offering integrated services. While providers were highly supportive of integrated services, they identified several challenges including widespread belief in FP myths among female clients, the need to consult a male partner prior to starting FP, lack of trained staff and space, and frequent stockouts of contraceptives and equipment. Addressing these challenges will be critical in designing future services.

The Participation of Street Food Sellers in Formulating the Policy of Revitalizing the Tegal’s Town Square Area as the Effort to Improve the Opened Green Zone

This research determined the participation of street food sellers in formulating and issuing the policy and determined the hindering factors of revitalization policy in the town square area of Tegal as the effort to improve the opened green zone. This descriptive qualitative research describes a variable in the form of spoken data from the informants and the observed behaviors of the informants. The researchers collected the data by interviewing the civil service police officers, the public work service and spatial planning, the cooperation of SME and trading, the housing and residential department, and the association of street food sellers; documenting; and studying the works of literature. The results found many regional government organizations participated in the formulation of revitalization policy. Then, they took the responsibility directly to the major of Tegal as the policy- maker of revitalizing the town square area of Tegal. The revitalization ran successfully. The government socialized the policy systematically and involved various actors including the street food sellers. However, from the eight socialization stage meetings for the street food sellers, only three socialization stages involved and coordinated with the street food sellers. The three meetings shared the divisions and relocation sites of the sellers, instruction, and empowerment. The revitalization of the green town square area also encountered some hindrances, such as limited socialization, lack of street seller confidence, and less representative relocated sites.

Depo-Provera, Class, Race, and the Domiciliary Family Planning Services in Glasgow and Haringey, 1970–1983

Abstract In 1976, the Committee of Safety of Medicines (CSM) in Britain authorized the contraceptive injectable Depo-Provera (DP) for short-term use and for two main reasons only: if a woman had received a rubella vaccine or if her partner had just undergone a vasectomy. Although officially authorized on restricted grounds only, the drug appears to have been widely prescribed by doctors of the Domiciliary Family Planning Services (DFPS). This article takes the prescription of DP in the DFPS of Haringey, a multiracial neighbourhood in London, and Glasgow as a comparative case-study to explore the intersections of medical authority, race, and class. Drawing on the archives of the Wellcome Collection, London, and the NHS Archives of the Mitchell Library in Glasgow, we show that the DFPS offered the ideal setting to test and prescribe Depo-Provera widely. In the hands of the medical profession, the drug at times became a tool of violence towards women from disadvantaged backgrounds. In doing so, we contribute to the wider, global history of DP, and illustrate how racist, classist, and ableist prejudices could shape family planning services in the British context.